Download Open Gallbladder Surgery

Open Gallbladder
Surgery
Treating Gallbladder Disease
A Common
Problem
If you’ve had a painful attack
of gallbladder symptoms,
you’re not alone. Gallbladder
disease is a very common
problem. Most often, the
symptoms are caused by
stones that form in the gallbladder. To treat the problem,
you will likely need to have
your gallbladder removed.
This eliminates pain and
prevents future attacks. Best
of all, you’ll be able to live
a full, healthy life without
your gallbladder.
Symptoms of Gallbladder Problems
Gallbladder problems can cause painful attacks, often after a meal.
Some people have only one attack. Others have many. The most
common symptoms of gallbladder attacks include:
•Severe pain or aching in the upper abdomen. The pain
may come and go. Or, it can remain constant.
•A dull ache beneath the ribs or breastbone.
•Back pain, or pain in the right shoulder blade.
•Nausea, upset stomach, heartburn, or vomiting.
How Gallbladder Problems Are Treated
To remove gallstones and prevent new ones from forming,
the gallbladder is removed. The operation is called a
cholecystectomy.
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Questions and Answers About Gallbladder Surgery
It’s normal to have some concerns about surgery. Below are answers to common questions:
•How is the gallbladder removed?
An incision is made in the abdomen. The
surgeon sees and works through this incision.
•Why not just remove the gallstones?
Unless the gallbladder is removed, more stones are
likely to form. The gallbladder may also need to
be removed for reasons other than gallstones.
•Will I need to change my diet?
No. Once you’ve fully recovered
from surgery, you can still eat all the
things you like.
Table of Contents
Understanding the Gallbladder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Your Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Planning Your Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Your Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Your Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
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Understanding
the Gallbladder
The gallbladder is a small, pearshaped organ in the abdomen.
Its job is to store and release
bile, a fluid made by the liver.
Bile helps break down fats in
the food you eat. Normally,
bile moves smoothly through
the digestive system. But if
stones form in the gallbladder,
they can block the release of
bile. This can cause pain and
lead to serious complications.
Liver
Stomach
When the Gallbladder Is Healthy
The gallbladder sits just beneath the liver in the upper right side
of the abdomen. When the gallbladder is healthy, it stores and
concentrates some of the bile made by the liver. After a meal, the
gallbladder squeezes bile into ducts (small tubes). The bile then
travels to the small intestine where it helps aid digestion.
Liver
Hepatic ducts
Cystic duct
Cystic artery
Gallbladder
Duodenum
Gallbladder
Common
bile duct
Small
Intestine
Stomach
Pancreas
Pancreatic
duct
Small
Intestine
How Bile Enters the Digestive System
Your liver makes bile. Most of the
bile is sent through a network of ducts
to the duodenum (first part of the small
intestine). A small amount of bile is also
sent to the gallbladder for storage.
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The gallbladder stores some bile.
The gallbladder concentrates the bile
by removing water. When bile is needed
to digest fats, hormones (chemical
messengers) signal the gallbladder to
squeeze bile out through the cystic duct.
Bile is sent to the duodenum. The
bile moves through the common bile
duct to the duodenum. There, it mixes
with food. The pancreas adds other
digestive juices. Digestion continues
in the small intestine.
When Gallstones Form
Most gallbladder problems are caused by gallstones. These form when substances in the
bile crystallize and become solid. In some cases, the stones don’t cause any symptoms. In
others, they irritate the wall of the gallbladder. More serious problems occur if the stones
move into nearby ducts and cause blockages. This stops the flow of bile and can lead to
pain, nausea, and infection. Jaundice (a buildup of bile chemicals in the blood) can
also occur. Symptoms include yellowing of the skin and eyes, dark urine, and itching.
Stomach
Gallstone blocking
the cystic duct
Inflamed,
tender
gallbladder
Gallstones
Common
bile duct
A stone in the common bile duct
can block the flow of bile and cause
inflammation, infection, and jaundice.
Duodenum
Ampulla
Pancreas
Pancreatic duct
Problems in the Common Bile Duct
The common bile duct is formed by the junction of ducts leading
from the liver and gallbladder. It’s also a common place for
problems to occur. This most often happens when a stone moves
from the gallbladder and blocks a section of the duct. This can
make bile back up into the liver, causing jaundice. If a gallstone
blocks the junction with the pancreatic duct, it can inflame the
pancreas and cause pancreatitis. This is a serious medical
condition that requires immediate treatment.
Pain caused by a blockage is often felt
in the upper right side of the abdomen.
You can also have pain in the shoulderblade, back, or beneath the breastbone.
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Your
Evaluation
Medical History and Physical Exam
You’ll need to have a thorough
medical evaluation before
any treatment is done. Your
doctor will ask about your
health and symptoms. You’ll
then have a physical exam. If
needed, your doctor may also
order other tests. Once the
evaluation is complete, your
doctor will talk with you about
treatment options.
Ultrasound Scan
Your doctor will ask about your symptoms. Be sure to mention the
location and frequency of any pain. Also mention any other health
problems you have. In addition, you may be asked about your
diet and any medications you take. You’ll then have a blood test and
physical exam. During the exam, your doctor may press on your
abdomen to check for pain.
If your doctor suspects you have gallstones, you’ll be scheduled for
an ultrasound scan. This test uses painless sound waves to check
for gallstones.
Other Tests
To learn more about your gallbladder problem, your
doctor may order one or more of the tests below.
CT scan (“CAT scan”)
A CT scan uses a series of x-rays to produce detailed
images of the body. These let your doctor view structures
in the abdomen and can help rule out other causes of
abdominal pain.
HIDA (Hepatobiliary scan)
A HIDA scan uses a radioactive fluid (marker) to
check gallbladder function. It can also show whether
any bile ducts are blocked. After the test, the fluid
safely passes from the body.
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Gallbladder
Gallstone
Common bile duct
Stone
Pancreas
ERCP (Endoscopic retrograde
cholangiopancreatography)
This test uses a thin, flexible scope that is guided
through the mouth and stomach to the bile
duct. The scope helps find and remove stones
from the duct. ERCP can also be performed
after gallbladder surgery to check for
stones in the duct.
Planning Your
Treatment
After the evaluation, your
doctor will talk with you
about treatment options. If
your stones are not causing
symptoms, you may choose
to delay surgery. But if you’ve
had one or more painful
attacks, your doctor will likely
recommend removing your
gallbladder. This prevents
more stones from forming
and causing attacks. It also
helps prevent complications.
And after the gallbladder
is removed, your liver will still
make bile to aid digestion.
Getting Ready for Surgery
Your doctor will talk with you about preparing for surgery.
Follow all the instructions you’re given and be sure to:
Risks and Complications
of Gallbladder Surgery
Gallbladder surgery is safe.
But it does have certain
risks. These include:
•Bleeding
•Infection
•Injury to the common
bile duct or nearby organs
•Blood clots in the legs
•Prolonged diarrhea
•Bile leaks
•Neuroma (painful spot) or
numbness near incisions
•Hernia formation at the
incision site
•Tell your doctor about any medications, supplements, or herbs
you take. You may need to stop taking them before surgery.
•Stop taking aspirin, ibuprofen, and naproxen as directed.
•Ask your doctor what to do if you take prescription blood thinners,
such as Coumadin (warfarin) and Plavix.
•Don’t eat or drink anything after the midnight before your surgery.
This includes water and coffee.
•Arrange for an adult family member or friend to give you a ride
home from the hospital.
If You’re Pregnant
Gallbladder problems may develop during pregnancy. This is because
hormone changes can make bile more likely to form stones. If your
gallbladder needs to be removed, your doctor will talk with you about
the timing for surgery. In some cases, it can be delayed until after
childbirth. But if your symptoms are severe, your doctor may advise
having surgery during your pregnancy. This is done to protect you
and your baby’s health.
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Your Surgery
Your surgery will be done in a hospital. If you
have questions, be sure to talk with your doctor
ahead of time.
The Day of Surgery
Arrive at the hospital on time. You’ll be asked to change into
a patient gown. You’ll then be given an IV to provide fluids and
medication. Shortly before surgery, an anesthesiologist will talk
with you. He or she will explain the medications used to prevent
pain during surgery. Gallbladder surgery is done using general
anesthesia. This lets you sleep during the procedure.
Finding Stones with X-Rays
During surgery, a cholangiogram catheter may be inserted into the
bile duct. The catheter is a thin tube used to inject a special dye.
Once the dye is injected, an x-ray is taken of the bile duct. This
helps show whether any stones have moved from the gallbladder
into the duct. If needed, the stones can then be removed.
A cholangiogram catheter injects
dye into the bile duct. The dye helps
reveal stones when x-rays are taken.
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During Surgery
An incision is made in the abdomen. The
incision may be made in the upper right side (solid
line) or middle (dashed line) of the abdomen.
The open incision gives your doctor a clear view
of the gallbladder and bile ducts.
Small clips or sutures close off the bile duct
and blood vessels. These help prevent bleeding
and bile leaks. The clips are made of titanium
(metal) or plastic that does not harm the body.
If clips are used, they will remain in place.
Clips
The gallbladder is removed. Once the clips are
secured, the gallbladder is detached from the liver.
It is then carefully lifted out of the abdomen. Bile will
now flow directly from the liver to the small intestine.
The incision is closed with sutures or staples.
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Your Recovery
After open surgery, you’ll
need to stay in the hospital
for a few days. Once you’re
home, follow your doctor’s
instructions to manage pain
and care for your incisions. As
you feel better, you can start
returning to your routine.
Recovery in the Hospital
When to Call Your Doctor
Call your doctor if you
notice any of the following
during recovery.
•Fever over 101°F (38.3°C)
•Chills
After surgery you’ll be taken to a recovery area. Bandages will cover
your incision and you may have special boots on your legs to prevent
blood clots. To aid recovery, you’ll be asked to get up and move as
soon as possible. You may also be asked to use a device that helps
keep your lungs clear.
Managing Pain
•Increasing redness or
drainage from the incision
It’s normal to have some pain during recovery. To help you feel better,
your doctor will prescribe pain medications to use at home. Be sure
to use them as directed. Because some pain medications can cause
constipation, your doctor may also suggest a laxative or stool softener.
•Vomiting or nausea that
lasts more than 12 hours
After Open Surgery
•Sharp or increasing pain
•Shortness of breath
•Pain or swelling in
your calf
•Symptoms of jaundice
•Prolonged diarrhea
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Recovering from open surgery may be painful. This is because an
incision was made in the abdominal muscles to remove the gallbladder. The muscles will heal. But for a time, it may hurt to bend,
stand, or take deep breaths. To help manage pain, you may receive
a special pump that lets you give yourself pain medication. Keep in
mind, you still need to move around as often as you can. This helps
prevent blood clots and can help you heal.
Recovery at Home
You will likely feel tired and may have some bruising
around the incision. You may also have some cramping
after a few days. This is normal and goes away in time.
To speed healing:
•Follow your doctor’s instructions about bathing and
caring for your incision.
•Talk with your doctor about what to eat. You may
need to start with light meals.
•Walk and move around as often as possible. This
improves blood flow and can help you feel better.
Easing Back into Activities
You can start getting back to your normal routine as soon
as you feel able. Just take it easy at first and follow all your
doctor’s advice. For best results:
•Ask your doctor about driving and going back to work.
It may be up to 6 weeks before you are able.
•Use pain relievers with acetaminophen to relieve
occasional discomfort.
•You can have sex again when you’re ready.
Eating Healthy Meals
Even though your gallbladder has been removed, you
don’t need to be on a special diet. However, it often takes
a few weeks for your digestion to adjust. You may have
indigestion, loose stools, or diarrhea. This is normal
and should go away in time. To aid digestion, eat a
balanced diet that is high in fiber. And if diarrhea or
other problems don’t go away, be sure to tell your doctor.
Having Follow-up Care
Keep follow-up appointments during your recovery.
These allow your doctor to check your progress and
make sure you’re healing well. During office visits,
tell your doctor if you have any new or unusual
symptoms. Your doctor can also help answer any
questions or concerns you may have.
Regular exercise helps speed recovery
and can improve your overall health.
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Feeling
Good Again
Don’t let gallbladder
problems put limits on
your life. By having surgery
to remove your gallbladder,
you can prevent painful
attacks. You can also avoid
future problems. And you’ll
still be able to enjoy all
your favorite foods and
activities. So see your
doctor for treatment. You
can feel good again.
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This product is not intended as a substitute for professional medical care.
Only your doctor can diagnose and treat a medical problem.
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